A 52-Year Journey to Diversity at UF

A recent article on the topic of diversity within the UF Department of Radiation Oncology has earned the attention of other institutions seeking to affect change in their own residency programs.

Published ahead of print on December 4, 2020 in the American Journal of Clinical Oncology, “Journey to Diversity in a University Radiation Oncology Residency Program: The Role of Leadership and Target Goals” plots the department’s diversity percentages over the past 52 years and highlights the role that leadership has played in lasting change.[1]

Authored by Drs. Robert J. Amdur, Rodney R. Million Professor of Radiation Oncology; Nancy Mendenhall, Associate Chair; William Mendenhall, Professor; Roi Dagan, Clinical Associate Professor and Assistant Residency Program Director; Anamaria Yeung, Associate Professor and Residency Program Director; and Paul Okunieff, Chair, the article follows the representation of residents each year between 1967 and 2020 in the categories of white male, female, under-represented minorities, and people of color.

First Steps

While it is widely accepted that collecting data and tracking change are among the first steps to increasing accountability and transparency in any institution,[2] it is also understood that doing so can be one of the most painful and challenging to accomplish.

“In the past five years, issues related to diversity in medicine in general and radiation oncology in particular have been high profile in peer reviewed journals and discussions at national meetings,” said Dr. Amdur. “I was encouraged to see this because it has been a high priority for me and most of the other faculty in our department for decades.”

However, he also noted two significant deficits in these discussions: 1. Specific recommendations on how to increase diversity, and 2. Data on what exactly has happened in programs regarding diversity over time. “We organized our project to fill these voids,” he explained.

The Role of Leadership in Real Change

As the article reveals, the UF Radiation Oncology Residency Program experienced a dramatic upswing in overall diversity by 40 percentage points between 1992 and 1995, a change maintained through 2020 (percentage of University of Florida radiation oncology resident physicians that were a person of color, by year, shown above). The main reason given for the increase was the appointment of Dr. Nancy Mendenhall as Chair of the Department in 1992 and her efforts in supporting and promoting diversity. Tools that also made a difference were measuring the program’s diversity profile and setting target goals.

Surprisingly, the department’s diversity agenda was implemented in meetings, rather than written in any policy document. “I think sometimes it’s better not to write down policies, especially when we are talking about numbers for diversity endpoints,” Dr. Amdur remarked. “It is better to have the flexibility that comes from setting specific number endpoints, and then being able to change them in any given year as fits best with the situation. Writing number goals down decreases flexibility.”

No matter what tools are employed, it is important to note that radiation oncology residency programs lacking inclusive leadership are ultimately doomed to fail in their efforts to increase diversity. “Leadership is critical to success,” he emphasized. “Without leadership at the highest level actively driving a diversity agenda, there is no chance of progress.”

Comparative Data? There’s No Comparison to UF – Yet

For most readers, the thought of sifting through 52 years of data is a daunting one; however, as Dr. Amdur relates, the team’s internal investigations encountered no serious obstacles because of the department’s “fantastic” research office and excellent records. It was a different story when it came to the need for comparative data. “We can’t evaluate comparison to other programs over time because there is no database that has [similar] data. This was a frustration from the academic standpoint because multiple reviewers of the paper wanted to see comparative data.”

To solve this, Dr. Amdur recommends that every individual program carry out the same project. “Many directors or chairs from other programs asked for our project slides before the manuscript was published,” he said. “They gave me positive feedback and said that they wanted to use our experience as a model for how to establish diversity goals, monitor performance relative to these goals, and improve the chance of achieving them.”

To read the entire “Journey to Diversity in a University Radiation Oncology Residency Program: The Role of Leadership and Target Goals” article, visit the American Journal of Clinical Oncology website.